Radiation Oncology/Bile duct/Staging

Extrahepatic bile ducts Current staging AJCC 7th Edition (2009) For the 7th Edition staging, there are now separate staging classifications for perihilar (proximal) and distal bile duct tumors Perihilar Bile Ducts Primary Tumor: Tis - carcinoma in situ T1 - confined to the bile duct, with extension up to the muscle layer or fibrous tissue T2 T2a - invades beyond the wall of the bile duct to surrounding adipose tissue T2b - invades adjacent hepatic parenchyma T3 - invades unilateral branches of the portal vein or hepatic artery T4 - invades main portal vein or its braches bilaterally; common hepatic artery; second-order biliary radicals bilaterally; or unilateral second-order biliary radicals with contralateral portal vein or hepatic artery involvement Regional Lymph Nodes: N0 - no N1 - regional lymph node metastasis (along the cystic duct, common bile duct, hepatic artery, and portal vein) N2 - metastasis to periaortic, pericaval, superior mesenteric artery, and/or celiac artery lymph nodes Distant Metastases: M0 - no M1 - yes Stage Grouping: I - T1 N0 II - T2a-b N0 IIIA - T3 N0 IIIB - T1-3 N1 IVA - T4 N0-1 IVB - N2 or M1 Distal Bile Duct Primary Tumor: Tis - carcinoma in situ T1 - confined to the bile duct T2 - invades beyond the wall of the bile duct T3 - invades the gallbladder, pancreas, duodenum, or other adjacent organs without involvement of the celiac axis or the superior mesenteric artery T4 - involves the celiac axis or the superior mesenteric artery Regional Lymph Nodes: N0 - no N1 - regional lymph node metastasis Distant Metastases: M0 - no M1 - yes Stage Grouping: IA - T1 N0 IB - T2 N0 IIA - T3 N0 IIB - T1-3 N1 III - T4 IV - M1 Prognostic factors : serum CEA, CA19.9 Changes from 6th Edition: Now separate staging classifications for perihilar and distal extrahepatic bile duct tumors Previous editions AJCC 6th Edition (2002) For the 6th edition - all extrahepatic bile duct tumors (perihilar or distal) are included in one classification Primary Tumor: Tis - carcinoma in situ T1 - confined to the bile duct T2 - invades beyond the wall of the bile duct T3 - invades liver, gallbladder, pancreas, and/or unilateral branches of the portal vein or hepatic artery T4 - invades main portal vein or its braches bilaterally, common hepatic artery, or other adjacent structures such as the colon, stomach, duodenum, or abdominal wall (unresectable) Regional Lymph Nodes: N0 - no N1 - yes Distant Metastases: M0 - no M1 - yes Stage Grouping: IA - T1 N0 IB - T2 N0 IIA - T3 N0 IIB - N1 III - T4 IV - M1 AJCC 5th edition (1997) Primary Tumor: T1 T1a - invades subepithelial connective tissue T1b - invades fibromuscular layer T2 - invades perifibromuscular connective tissue T3 - invades adjacent structures (liver, pancreas, duodenum, gallbladder, colon, stomach) Regional Lymph Nodes: N1 - metastasis in cystic duct, pericholedochal and/or hilar lymph nodes (i.e in the hepatoduodenal ligament) N2 - metastasis in peripancreatic (head only), periduodenal, periportal, celiac, and/or superior mesenteric and/or posterior pancreatic duodenal lymph nodes Stage grouping: I - T1 N0 II - T2 N0 III - T1-2 N1-2 IVA - T3 Any N IVB - M1 Intrahepatic bile ducts AJCC 7th Edition (2009) Note: New staging category beginning with the 7th edition. In prior editions, staging for intrahepatic bile ducts was grouped in with Liver staging. Primary tumor: Tis - carcinoma in situ (intraductal tumor) T1 - solitary tumor without vascular invasion T2 T2a - solitary tumor with vascular invasion T2b - multiple tumors, with or without vascular invasion T3 - tumor penetrating the visceral peritoneum or involving the local extrahepatic structures by direct invasion T4 - tumor with periductal invasion Regional Lymph Nodes: Regional nodes: Right liver (segments 5-8) - hilar (common bile duct, hepatic artery, portal vein, and cystic duct), periduodenal, peripancreatic, inferior phrenic Left liver (segments 2-4) - hilar, gastrohepatic, inferior phrenic Distant nodes (M1) - celiac, periaortic, pericaval N0 - no N1 - yes Distant Metastases: M0 - none M1 - yes Stage Grouping: I - T1 N0 II - T2 N0 III - T3 N0 IVA - T4 N0, Any N1 IVB - M1